Case of the Week — April Case #1: Eye Pain

A 73 y/o AAF presents to the ED with eye pain and headache for the past 12 hours. She states that she has been blind for the past 3 years, but has never had pain associated with her lack of vision. She reports a 10/10 headache which began gradually after she came home from hemodialysis earlier in the day. She denies nausea, vomiting, fever or neck stiffness. She describes her headache as global in nature. PMHx: DM, HTN, ESRD, cataracts PSHx: none Meds: blood pressure and diabetes meds Allergies: NKDA SocHx: lives with her daughter, denies ETOH, drugs or tobacco use PE: BP 221/110, P 60, R 16, T 98.5, Pox 98% (RA) GEN: WNWD, AAF, appears in pain, moaning HEENT: Pupils difficult to visualize due to cataracts, EOMI intact, no scleral injection or icterus, lids lashes and lacrimals normal without evidence of infection, fluoresceine uptake negative, unable to visualize fundus, difficult to visualize anterior chamber clearly due to large cataracts, IOP normal. No temporal TTP, normal neck flexion CHEST: CTA B, nonlabored CV: RRR, no M/R/G ABD: soft, NTND, +BS Bedside ultrasound is performed to evaluate the retina and for ICP. What do these images demonstrate? Thanks to Dr. Ashley Doescher for the images in this case!